The Long Term Efficacy of an Intensive Lifestyle Intervention versus Bariatric Surgery to Treat Morbid Obesity in Women

Objective: The effectiveness of behavioral/lifestyle interventions in treating morbidly obese individuals is questionable. Aim of the present study was to compare the long-term efficiency of an intensive lifestyle intervention to bariatric surgery in morbidly obese women.
Methods: Twenty-nine morbidly obese females participated in this study. Fifteen subjects were assigned to the Lifestyle Group and 14 underwent vertical banded gastroplasty. Participants in the Lifestyle Group attended 30 behavioral modification sessions over three years, whereas the Surgery Group received the standard of care nutrition after bariatric surgery. Body weight, resting metabolic rate, physical activity, body composition measurements and dietary intake data were assessed repeatedly during the first 3 years postintervention. Body weight and physical activity information were also collected 9 years later.
Results: The Surgery Group lost significantly more weight in the first 3 months, and at 1, 2 and 3 years after surgery compared to the Lifestyle Group (P=0.004). However, at 9 years weight loss was similar between groups. Furthermore, at 9 years, the same percentage (61.5%) of participants in both groups lost and maintained at least 5% of their initial body weight. Physical activity level was more elevated in the Lifestyle Group compared to the Surgery Group throughout the study. 

Conclusion: Surgery led to significantly more weight loss than the lifestyle intervention in the first post-intervention years. However, 9 years later both groups ended with similar weight loss, indicating that an intensive lifestyle intervention should not be ignored for treating morbid obesity, as it represent a safe, efficacious and costeffective
approach.